Child-Focused State Cash Transfers & Adolescent Risk of HIV Infection in South Africa: A Propensity-Score-Matched Case-Control Study

Effective and scalable HIV prevention for adolescents in sub-Saharan Africa is needed. Cash transfers can reduce HIV incidence through reducing risk behaviours. However, questions remain about their effectiveness within national poverty-alleviation programmes, and their effects on different behaviours in boys and girls.

In this case-control study, we interviewed South African adolescents (aged 10-18 years) between 2009 and 2012. We randomly selected census areas in two urban and two rural districts in two provinces in South Africa, including all homes with a resident adolescent. We assessed household receipt of state-provided child-focused cash transfers, incidence in the past year and prevalence of transactional sex, age-disparate sex, unprotected sex, multiple partners, and sex while drunk or after taking drugs. We used logistic regression after propensity score matching to assess the effect of cash transfers on these risky sexual behaviours.

We interviewed 3515 participants (one per household) at baseline, and interviewed 3401 at follow-up. For adolescent girls (n=1926), receipt of a cash transfer was associated with reduced incidence of transactional sex, and age-disparate sex, with similar associations for prevalence (for transactional sex, OR 0·47, 95% CI 0·26-0·86; p=0·015; for age-disparate sex, OR 0·37, 95% CI 0·18-0·77; p=0·003). No significant effects were shown for other risk behaviours. For boys (n=1475), no consistent effects were shown for any of the behaviours.

National, child-focused cash transfers to alleviate poverty for households in sub-Saharan Africa can substantially reduce unsafe partner selection by adolescent girls. Child-focused cash transfers are of potential importance for effective combination strategies for prevention of HIV.

Below:  Incidence in the past year of risky sexual behaviours by adolescent girls

Table 3

Incidence of risky sexual behaviour in the past year, by household grant receipt and sex

Data are n (%).

Full article at: http://goo.gl/50wMlE

By: Cluver L1, Boyes M2, Orkin M3, Pantelic M2, Molwena T4, Sherr L5.

• 1Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa. Electronic address: lucie.cluver@spi.ox.ac.uk.
• 2Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
• 3School of Public and Development Management, University of the Witwatersrand, Johannesburg, South Africa.
• 4Cape Town Child Welfare, Cape Town, South Africa.
• 5Royal Free and University College Medical School, University College London, London, UK.  

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